{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TONYA   L COOK","gend":1,"add":"324 CLEVELAND ST APT 9","city":"DANVILLE","state":"VA","zip":"24541-9998","dob":"1980-03-05","age":"","mstatus":"","insh":"20025743*01","cliId":"","pno":"434\/713-5811","cno":"434\/333-8753","email":"","ename":"","eno":"","pphy":"MARILLA, SHEREE NP","ppno":"434\/656-1274","pcpadd":"291 MCBRIDE LANE","pcpcity":"GRETNA","pcpstate":"VA","pcpzip":24557,"pcpcounty":"","pcpid":"","pcpname":"CENTRA MEDICAL GROUP LLC","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/656-3405","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.81","F10.10","F12.10","F14.10","F31.9","M79.622","R22.0","R09.02","W10.8XXA","T78.3XXA","J45.909","F17.210","Z88.0","R07.89","F17.200","E87.6","Z13.31","J44.9","L73.2","J30.9","J44.1","R09.81","L72.3","G56.02","G56.01","G56.03","M19.042","M19.041","E66.3","M79.641","M79.642","M25.572","Z11.3","E66.9","S52.002A","M25.522","E78.5","E55.9","G56.00","M79.89","Z00.00","M79.673","Z79.899","J18.9","L70.0","S49.92XA","W10.9XXA","Y93.02","Z28.21","Z09.","R45.89"],"date":["2020-09-14","2020-09-14","2020-09-14","2020-09-14","2021-03-16","2021-10-16","2021-10-16","2021-10-16","2021-10-16","2019-01-28","2021-09-17","2021-04-22","2020-11-29","2020-11-29","2021-09-17","2021-09-17","2021-03-16","2021-04-22","2021-06-24","2021-09-17","2020-11-29","2019-04-10","2021-06-24","2020-05-26","2021-06-02","2020-05-26","2021-06-02","2021-06-02","2020-06-17","2020-06-17","2020-06-17","2021-06-02","2020-03-21","2021-04-22","2021-11-17","2021-11-17","2021-09-17","2021-09-17","2021-09-17","2020-03-20","2020-03-20","2020-03-20","2020-03-20","2020-11-29","2021-06-24","2021-10-16","2021-10-16","2021-10-16","2019-11-08","2020-12-10","2021-03-16"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Review of Systems and Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":"","a13":""}]}]}